Provider Demographics
NPI:1841827771
Name:HENS, JENNIFER (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:HENS
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14189 CAMINITO VISTANA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3722
Mailing Address - Country:US
Mailing Address - Phone:801-712-3455
Mailing Address - Fax:
Practice Address - Street 1:1000 W WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1873
Practice Address - Country:US
Practice Address - Phone:619-295-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1089251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics